POS0038 UTILIZATION OF CARDIOVASCULAR PREVENTIVE SERVICES IN A RHEUMATOID ARTHRITIS POPULATION BASED COHORT
Authors: D. Montes, C. A. Hulshizer, E. Myasoedova, J. M. Davis, A. Hanson, A. Duarte-Garcia, G. Figueroa-Parra, B. Chevet, C. S. Crowson
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) increases the burden of cardiovascular disease (CVD). Fasting blood glucose, fasting lipoprotein profiles, and blood pressure measurements are recommended at regular intervals to screen for classical CVD risk factors of diabetes mellitus (DM), hyperlipidemia (HLD), and hypertension (HTN), respectively. <h3>Objectives</h3> Our objectives were 1) to perform a contemporary assessment of the trends of CVD preventive service utilization in patients with RA compared to matched non-RA comparators, 2) identify RA patient characteristics that may influence trends in preventive services utilization, and 3) assess how a diagnosis of RA alone influences approaches to CVD prevention compared to the other classical CVD risk factors. <h3>Methods</h3> Inpatient and outpatient medical records for each potential case were manually reviewed. All incident patients fulfilled the 1987 American College of Rheumatology (ACR) classification criteria for RA or the 2010 European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) criteria. All ≥19-year-old patients with an RA diagnosis living in an 8-county region on January 1, 2015 (index date), were included and matched (1:1) by sex, age, and county to non-RA comparators. Rates of screening for the classical CVD risk factors were compared between groups using Cox models with adjustment for age, sex, and race. <h3>Results</h3> DM screening was more common among patients with RA ([HR] 1.10, 95% CI 1.01–1.19), as was HTN screening ([HR] 1.37, 95% CI 1.24–1.52). However, HLD screening in RA was similar to comparators ([HR] 0.99, 95%CI 0.89–1.10). RA patient characteristics that influenced classical CVD risk factor screening included: smoking history, obesity, RA duration of &lt; 5 years, older age at the time of RA diagnosis, a higher Charlson comorbidity index, the use of &gt;90 days of glucocorticoid therapy before the index date, the use of disease modifying anti-rheumatic drugs before the index date, and living in the lowest quartile of the Area Deprivation Index within our cohort. Lastly, patients with RA and no classical CVD risk factors had a lower probability of undergoing DM ([HR] 0.67, 95% CI 0.57–0.78) and HLD screening ([HR] 0.65, 95% CI 0.54–0.79) than non-RA patients with one classical CVD risk factor diagnosis. HTN screening was similar between both groups ([HR] 1.01, 95% CI 0.83–1.23). <h3>Conclusion</h3> RA patients undergo CVD preventive screening at rates at least comparable to the general population. However, despite the equivalent-to-higher CVD risk, RA does not appear to be approached as aggressively as traditional CVD risk factors. (1,2) These findings demonstrate an opportunity to improve RA patient care. While EULAR provides guidance for stratifying CVD risk in patients with inflammatory joint disease, there is no equivalent guidance from American medical bodies. (3) Given our findings, clinical practice in the United States could benefit from establishing such recommendations. These recommendations should be forceful in framing RA as conferring an equivalent-to-higher CVD risk as the classical CVD risk factors. <h3>References</h3> [1]Liao KP., Rheumatology (Oxford). 2013 [2]Solomon DH., Ann Rheum Dis. 2006 [3]Agca R., Ann Rheum Dis. 2017 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Daniel Montes: None declared, Cassondra A Hulshizer: None declared, Elena Myasoedova: None declared, John M Davis III Grant/research support from: Pfizer, Andrew Hanson: None declared, Ali Duarte-Garcia: None declared, Gabriel Figueroa-Parra: None declared, Baptiste Chevet: None declared, Cynthia S. Crowson: None declared.